Provider Demographics
NPI:1164936415
Name:MITCHELL, MARCEDES
Entity Type:Individual
Prefix:
First Name:MARCEDES
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 605455
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-0455
Mailing Address - Country:US
Mailing Address - Phone:440-319-1347
Mailing Address - Fax:
Practice Address - Street 1:3991 E 71ST ST REAR HOUSE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-7319
Practice Address - Country:US
Practice Address - Phone:440-319-1347
Practice Address - Fax:440-319-1347
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-23
Last Update Date:2017-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0231608Medicaid